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Minnesota rates for HCPCS Q4248

Dermacyte Amniotic Membrane Allograft, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $660.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $3,715.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $125.89 / $2,398.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $3,311.31 / $4,570.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,230.27 / $1,445.44
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $3,467.37 / $4,265.80
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,202.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $2,818.38 / $4,365.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $2,818.38 / $3,801.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $2,290.87 / $2,884.03